Post-COVID-19 Barriers to Diabetic Retinopathy Screening Attendance: An Updated Systematic Review

Diabetic retinopathy (DR) is a preventable cause of vision loss; with screening, there is the capability to recognise and treat the condition early. However, screening compliance remains sub-optimal, and the COVID-19 pandemic caused widespread disruptions to the screening programme. This review aims to update prior systematic reviews to identify barriers that remain, as well as identify new barriers that may have occurred due to the pandemic. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines, we searched seven databases (January 2020-July 2025) for English language primary studies on DR screening non-attendance, yielding 16 relevant studies across diverse regions. Key barriers fell into patient-related, health system, and environmental categories. Although there was evidence to suggest the same barriers remained, there is evidence to suggest the pandemic exacerbated prior barriers and introduced new barriers. These findings suggest the need for context-specific interventions to improve DR screening in the post-pandemic era.